MEDICARE: WARREN EYE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7165TG	TX

General Provider Information

NPI Number	:	1134306582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	5401 SOUTH FM 1626
Second Line	:	SUITE 135-B
City	:	KYLE
State	:	TX
Zip	:	78640-6038
Country	:	US
Telephone Number	:	512-268-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 SOUTH FM 1626
Second Line	:	SUITE 135-B
City	:	KYLE
State	:	TX
Zip	:	78640-6038
Country	:	US
Telephone Number	:	512-268-8400
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. ANDREW DALE WARREN
Credential	:	O.D.
Telephone Number	:	512-268-8400

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/30/2008

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